We tend to do things for a reason y'all...

Sometimes patients, both confused and oriented patients, think we do things just for the heck of it. Or for money, or for control, or for power, or even, according to some, it's straight up that we don't know what we're doing and we're idiots. Usually it's confused patients making these claims, but I see oriented patients making these claims too. However, this story was a confused patient. Believe it or not, we do tend to do medical interventions for a reason... In this case, we had a young heart failure patient on telemetry monitoring (remote heart monitor). Only problem was, according to him, his heart was "fine" and he "didn't need it".

Typically when oriented patients refuse something like tele, we provide education and if they still refuse, we simply document it and remove the tele. When they're confused, sometimes we'll try things like attaching tele on their back where it's hard to reach to remove or assigning a sitter in the room. This doesn't always work though.

This patient was young, strong, and agile. But he was very, very sick, so even at a young age, he was mentally pretty impaired. He would tell us his heart is fine and he doesn't need the monitor, and would repeatedly pull it off, even when we tried putting it on his back. He was very agitated most of the time, and often verbally abusive. There's really not a whole lot you can do to convince those types of patients of something they don't believe. Eventually, we were forced to give up and just document, document, document.

One day, our worst fear became a reality. Without his tele monitor on, it was impossible for us to know what his heart was doing. All we could do was check on him frequently to make sure he was still breathing. But one of those times checking on him, we found him in cardiac arrest. We did CPR for I believe it was upwards of 40 minutes, but since we found him that way, it was very possible he had been laying in bed in cardiac arrest for 20+ minutes. It was not a surprise to any of us that we ended up calling it and he did not survive.

Moral of the story: Tele saves lives. We are honestly far too busy at work to be doing things we don't believe are necessary. While every patient has the right to refuse interventions, it's important to always try to educate, and document, document, DOCUMENT.